tbuckley/cabot-search huggingface dataset:
Abstract 11840: A Meta-Analysis of the Long-Term Outcomes of Acute Myocardial Infarction in Preexisting Coronary Artery Ectasia
Authors: Mohamed Eid, Mostafa R Mostafa, Ahmad Al-Abdouh, Mahmood Mubasher, Sarah Mohamed, Mamas Mamas
Journal: Circulation (2022)

Introduction: Coronary artery ectasia is associated with an increased risk of acute myocardial infarction. Hypothesis: This meta-analysis evaluates outcomes following acute myocardial infarction in patients with preexisting coronary artery ectasia. Methods: This meta-analysis was conducted according to PRISMA guidelines. A search strategy was designed to utilize PubMed/Medline, EMBASE, and Google scholar for studies showing the outcomes of acute myocardial infarction in patients with coronary artery ectasia from inception to February 10, 2022. We reported effect sizes as odds ratio (OR) with a 95% confidence interval (CI). We used I 2 statistics to estimate the extent of unexplained statistical heterogeneity: I 2 greater than 50% was considered a high degree of between-study statistical heterogeneity. Results: Of 217 studies initially identified, 7 studies comprising 13499 patients were included in the final analysis. There was no significant difference between patients with coronary ectasia and patients without coronary ectasia in terms of all-cause mortality (OR 0.95; 95% CI 0.58 to 1.56; p = 0.79; I 2 =0%) , MACE (OR 4.04; 95% CI 0.34 to 47.57; p = 0.17; I 2 =95%), myocardial reinfarction (OR 2.13; 95% CI 0.83 to 5.47; p = 0.08; I 2 =59%), target vessel revascularization (OR 1.31; 95% CI 0.69 to 2.48; p = 0.21; I 2 =0%), or requiring mechanical supportive devices (OR 1.32; 95% CI 0.22 to 7.83; p = 0.57; I 2 =56%). (Figures 2-A, B, C, D) Conclusions: Acute myocardial infarction in the presence of coronary artery ectasia is not linked to an increased risk of death, major cardiovascular events, myocardial infarction, or the need for mechanical circulatory support.
Abstract 11919: Differences in the Documentation of Atrial Fibrillation Symptoms in Electronic Health Records Between Patients With and Without Comorbid Heart Failure
Authors: Mollie Hobensack, Meghan Reading Turchioe
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) causes burdensome symptoms that impact quality of life. One in four AF patients have comorbid heart failure (HF). Understanding whether comorbid HF impacts AF symptom experiences can guide interventions for symptom management. Objective: We aimed to investigate whether patients with AF and comorbid HF will have different symptoms compared to those with AF only. Methods: We used structured and unstructured data (i.e., clinical notes) from electronic health records of patients in a large, urban health system between 2010-2010. We created two cohorts: (1) AF only, and (2) AF and HF. We extracted symptoms from notes written immediately before a catheter ablation to treat AF because of high symptom enrichment in ablation consultation notes compared to general progress notes. To extract symptoms, we applied a natural language processing algorithm with high performance on the corpus of notes (precision=0.73, recall=0.93, F-score=0.81). A team of cardiologists and nurses with cardiology expertise chose 10 symptoms to evaluate. We used Chi squared tests to compare differences in the prevalence of documented symptoms between cohorts. We further characterized each cohort using the structured demographics data. Results: Patients with AF only (n=504) had a mean age of 65.1 (SD 10.5) years, 33.3% were documented as female, and 14.3% documented as non-White. Patients with AF and HF (n=575) had a mean age of 69.4 (SD 12.0) years, 38.8% were documented as female, and 23.5% documented as non-White. The HF and AF cohort had a significantly higher prevalence of 6 symptoms (Table 1). The AF only cohort had a significantly higher prevalence of one symptom (palpitations). Conclusions: There are clear differences in the prevalence of symptoms between cohorts, with HF patients experiencing greater symptom burden overall. Future work exploring differences, such as through symptom clusters, will further illuminate differences in symptom experiences.
Abstract 12700: Post-GWAS Functional SNP Analysis to Define Genetic and Acquired Pathogenesis of Pulmonary Arterial Hypertension
Authors: Wei Sun, Danli Jiang, Gang Li, Stephen Y Chan
Journal: Circulation (2022)

Introduction: Pulmonary arterial hypertension (PAH) is an enigmatic and morbid disease where insights are emerging regarding genetic susceptibility. Genome-wide Association Studies (GWAS) have identified genomic SNPs associated with increased PAH risk. It has been challenging to define the mechanisms underlying the contribution of non-coding PAH-associated functional SNPs (fSNPs) to the pathogenesis of this disease. Methods: We developed a post-GWAS functional genomics strategy to define the causative fSNPs and the associated biological mechanisms. It includes Reel-seq (Regulatory element-sequencing), an EMSA-based technique to identify fSNPs in a synthetic SNP library; SDCP-MS (SNP-specific DNA competition pulldown-mass spectrometry) to identify proteins that specifically bind to fSNPs; and AIDP-Wb (allele-imbalanced DNA pulldown-Western blot) to show allele-imbalanced binding of these proteins to fSNPs. The regulation of risk gene expression by fSNP-binding proteins and their pathogenicity were determined in human pulmonary arterial endothelial cells (PAECs) and confirmed in PAH animal models and patients. Results: An intergenic SNP rs4738801 was identified as a fSNP by Reel-seq. This non-coding fSNP resides in a remote upstream enhancer region of SOX17, an endothelial effector increasingly associated with PAH pathogenesis. Using SDCP-MS and AIDP-Wb, we found that transcription factor FUBP1 binds to rs4738801 risk allele C with lower affinity than non-risk allele G, resulting in a decrease in SOX17 expression. FUBP1 and target gene SOX17 controlled PAH-associated pathophenotypes in PAECs, including proliferation, apoptosis, and angiogenesis. Downregulated by major acquired PAH trigger hypoxia, FUBP1 and SOX17 were decreased in lungs and pulmonary ECs isolated from PAH patients and mouse models. A 3.8-fold enrichment of risk allele C was found in patients with PAH induced by hypoxia, but not in PAH associated with connective tissue disease or other etiology. CONCLUSION: Our functional genomics findings identify a novel role of FUBP1 in the functional regulation of SOX17 locus and elucidate a pathogenic mechanism that combines the acquired PAH-triggering factors and altered genetic susceptibility.
Abstract 12665: Using Healthcare Claims Data and Machine Learning to Identify Health Disparities for Individuals With Diagnosed and Undiagnosed Familial Hypercholesterolemia
Authors: Zahid Ahmad, Chao Xing, Amit Khera, Chun-Yuan Huang, Eric Brandt, Dianne MacDougall, Catherine D Ahmed, Mary P McGowan, Katherine A Wilemon, Kelly Myers
Journal: Circulation (2022)

Introduction: Individuals with Familial Hypercholesterolemia (FH) warrant intensive lipid lowering therapy starting with statins and adding ezetimibe and PCSK9 inhibitors (PCSK9i) as needed to achieve LDL-C treatment targets. Little data exists on whether disparities exist in the US FH population for ezetimibe, PCSK9i or the combination of statins + ezetimibe + PCSK9i. Methods: We queried the Family Heart Database, a healthcare claims database from the Family Heart Foundation, for filled prescriptions for statins, ezetimibe, and PCSK9i in patients with an ICD-10 diagnosis of FH (E.78.01) as well as undiagnosed FH patients (Probable FH) identified by the Family Heart Foundation’s FIND-FH® machine learning algorithm. Data were analyzed in multivariable models including age, education, income, race/ethnicity, and gender. Results: Among 77,671,959 individuals, 280,426 had an ICD-10 diagnosis of FH (51% female, 79.5% White, 11.8% Black, and 8.7% Hispanic) and 899,027 had Probable FH (48% female, 78.7% White, 12.9% Black, and 8.5% Hispanic). Diagnosed and Probable FH males were 46% and 48% more likely, respectively, than females to receive high intensity statins. Individuals in the $100,000+ income bracket - both the diagnosed and Probable FH groups - were 30 to 50% more likely to receive ezetimibe, PCSK9i, or statin + ezetimibe + PCSK9i (Table). The highest education level was associated with 51% higher odds of statin + ezetimibe + PCSK9i use in diagnosed FH patients. Whites were 6-30% more likely to get ezetimibe, PCSK9i, and the combination of statin + ezetimibe + PCSK9i compared to Blacks. Conclusions: Real world patterns of medical care reveal appropriate lipid lowering therapy is more often prescribed for individuals with FH who are White, have high income, or have advanced education. Efforts are warranted to improve equity and provide all individuals with FH an opportunity for cardiovascular risk reduction.
Abstract 114: Postconditioning With Argon Has No Direct Lung-protective Effect Against Ischemia Reperfusion In A Rat Isolated Lung Model
Authors: Josephine E Hees, William J Cleveland, Claudius Balzer, Matthias L Riess
Journal: Circulation (2022)

Cardiac arrest (CA) remains a significant medical problem with stagnating low survival rates. Ventilation with the noble gas Argon (Ar) after return of spontaneous circulation improved neurologically favorable survival in a porcine CA model. We hypothesized that postconditioning with Ar attenuates global ischemia reperfusion (IR) injury in a rat isolated lung model. Following Institutional Animal Care and Use Committee approval and conforming with the "Position of the American Heart Association on Research Animal Use", lungs of adult male Sprague Dawley rats (250-350 g) were isolated and positive-pressure ventilated (10 mL/kg body weight [BW]) at a respiration rate of 30 breaths/minute. Lungs were perfused with physiological crystalloid buffer at a constant flow of 40 mL/kg BW. The control (C) group (n=6-7) was ventilated with 65% N 2 , 5% CO 2 , 30% O 2 , the Ar group (n=6) with 65% Ar, 5% CO 2 , 30% O 2 before global no-flow ischemia for 8 min followed by reperfusion. Mean arterial (MAP) and airway pressures (AWP) were recorded continuously. Lung viability as survival time until development of fulminant pulmonary edema was noted. Data are mean +/- SEM. Statistics: Student's t-Test with *p&lt; 0.05. IR significantly increased MAP and AWP throughout reperfusion compared to baseline; contrary to our hypothesis, though, ventilation with Ar did not signficantly increase survival time (panel A) or lower MAP (B) or AWP (C) of the isolated lung during reperfusion in this model. In-vivo models may be better-suited to assess Ar’s organ-protective effects following CA.
Abstract 11981: Neutrophil-To-Lymphocyte Ratio and Ventricular Arrhythmia in Mitral Valve Prolapse
Authors: Suhani Gupta, Andrew Cesmat, Abdul Chaudry, Thelsa Weickert, Ross J Simpson, Faisal Syed
Journal: Circulation (2022)

Introduction: Inflammation may mediate the association of mitral valve prolapse (MVP) with ventricular scarring and arrhythmia. The purpose of this study is to investigate the association of neutrophil- and platelet-to-lymphocyte ratios (NLR, PLR) with ventricular arrhythmia in MVP. Hypothesis: We hypothesized that hematological markers of inflammation predict ventricular arrhythmia in MVP. Methods: Clinical and demographic data were extracted from electronic medical records for all patients aged 18-90 years with MVP on echocardiography between 2016-19 at our institution. We studied 65 patients who had a differential blood count within six months prior to an ambulatory ECG (A- ECG) monitor (median age [IQR] 69.6 [60.5-77.1] years; 61.5% female; 12.3% African American). Patients with surgery or infection within six months prior to CBC were excluded. PVC burden and complex ventricular ectopy (cVE) on A-ECG were compared with NLR and PLR. Logistic and bivariate regression was used to analyze clinical, ECG, and echocardiographic factors associated with NLR and PLR. Results: Factors associated with NLR were congestive heart failure (p=0.005), male sex (p=0.015), age (p=0.033), and bileaflet MVP (p=0.036). NLR was associated with absolute PVC burden (R2 0.08, p=0.023) and cVE (median [IQR] 3.1 [1.6 - 5.8]), versus without cVE (1.7 [1.6-3.1], p=0.044). An NLR of 5.6 yielded 50% sensitivity and 90% specificity for PVC burden &gt;1% (AUC 0.69). No significant association was found between PLR and PVC burden or cVE. Conclusions: NLR is associated with PVC burden and complex ventricular ectopy in MVP, suggesting that inflammation is a significant factor in the pathogenesis of ventricular arrhythmia in this condition.
Abstract 110: Threshold Adjusted Vagus Nerve Stimulation After Asphyxial Cardiac Arrest Results In Reduction Of Endoplasmic Reticulum Stress And Apoptosis
Authors: Rishabh C Choudhary, Umair Ahmed, Muhammad Shoaib, Stavros Zanos, Lance B Becker
Journal: Circulation (2022)

Background: Vagus nerve stimulation (VNS) has been shown to improve survival and neurological outcomes after cardiac arrest (CA) and resuscitation by improving mitochondrial function, increasing cerebral blood flow, and reducing inflammation. However, the therapeutic cellular and subcellular mechanisms of VNS are not clearly understood in CA injury. Endoplasmic reticulum (ER) stress after cardiac arrest also contributes to cell death and is an underexplored area. Objective: The aim of this study was to investigate the protective effects of customized threshold-adjusted VNS (tVNS) in a rat model of CA and resuscitation in reducing ER stress and cell apoptosis. Methods and Results: Sprague-Dawley rats underwent 12 min asphyxial-CA followed by resuscitation. Rats were assigned to either post-resuscitation tVNS for 2 h or no-tVNS (control). tVNS was applied by electrode placement in the left cervical vagus nerve immediately after resuscitation. The tVNS was determined by a 15-20% reduction from the immediate baseline heart rate as the effective and physiological threshold for each animal. This enabled customized parameters for individual animals. At 2 h post-ROSC, rats were perfused with normal saline, and the whole brain was removed. The whole brain was then processed for protein expression by western blotting. We also prepared sham rats that did not receive CA or tVNS. For measuring ER stress we evaluated the expression of p-IRE1α protein and for apoptosis, we measured p-BAD protein. We observed a significantly higher protein expression of p-IRE1α in whole brain tissue after CA in control groups in comparison to the sham (p&lt;0.05). Applying tVNS significantly reduced the expression of brain p-IRE1α in comparison to the control group (p&lt;0.05). CA also substantially increased de-phosphorylation of p-BAD protein compared to the sham group (p&lt;0.05). By contrast, no significant increase in de-phosphorylation of p-BAD protein was observed between the tVNS and sham groups. Conclusions: Application of tVNS immediately after 12 minutes of CA and resuscitation results in reduced ER stress and apoptosis. This data suggests that the protective mechanism of tVNS on cell apoptosis involves a reduction in ER stress. tVNS may be a novel therapeutic approach in CA.
Abstract 11675: Heart Failure Patients Express Preferences Toward Benefits of Feeling Well and Living Longer With Added Therapy
Authors: Madeleine R Alder, Justin Bachmann, Joann Lindenfeld, Russell Rothman, Allman Rollins, Meng Xu, Allison McCoy, Lynne W Stevenson
Journal: Circulation (2022)

Introduction: Therapies for heart failure (HF) in the United States have been approved to decrease hospitalizations and mortality rather than to make patients feel better. Patients considering possible benefits of a new therapy may express different preferences for feeling well versus living longer. Methods: During collection of patient-reported outcomes at HF clinic visits, patients described along a five-point scale the benefits they would want from an additional HF therapy in relation to feeling well or living longer. They were also asked if their quality of life (QOL) was limited mostly by HF, equally by HF and other medical problems, or mostly by other medical or non-medical problems. Pairwise comparisons were made between patients in 3 groups defined by those who valued living longer in preference to feeling well, those who regarded those benefits equally, and those who valued feeling well over living longer. Results: Between 7/2019-3/2021, responses during HF clinic visit at an academic center were provided by 1,876 patients. When asked what benefit they would want from a new treatment, 12% valued longevity over feeling well, 69% equally valued feeling well and living long, and 19% valued feeling well over living longer (Figure). Patients placing higher value on living longer were more likely to be younger and more likely to be African-American (both p&lt; 0.001). A majority of patients perceived that their QOL was limited as much or more by other medical or non-medical factors as by their HF. Conclusions: For an additional therapy, contemporary outpatients with HF express preference at least as often for benefit to feel well as to live longer, with the majority of patients ranking them as equal. As new treatments for HF are developed and approved, increasing emphasis is warranted on investigating their impacts on how patients feel.
Abstract 11773: Burden, Trends, Odds and Predictors of Acute Cardiac Events in Geriatric Patients Admitted With Comorbid Chronic Kidney Disease With vs. Without Cannabis Use - An Age Matched Nationwide Analysis, 2016-2019
Authors: Rupak Desai, Syed Mohammad Moosi Raza, ananth vallabh guddeti, Kshitij Mahajan, Advait Vasavada, Swapnil Surpur, Mani Chandan Reddy Patlolla, Ehrima Fatima, Zarna Bambhroliya, Paul Gbemudu, Akhil Jain
Journal: Circulation (2022)

Background: The impact of recreational marijuana use/cannabis use disorder (CUD) in elderly chronic kideney disease (CKD) patients remains unknown amidst the rising use of cannabis in the USA. We conducted a nationwide study to assess the impact of CUD on cardiovascular outcomes in these patients. Methods: We used National Inpatient Sample (2016-2019) and geriatric (≥65 years) admissions with CKD. We compared baseline characteristics, comorbidities and composite in-hospital outcomes [MACCE- all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and acute ischemic stroke-AIS] between the age-matched (1:1 propensity score matching) CUD+ vs. CUD- cohorts. Results: Age-matched (median 70 years, p=0.998) geriatric CKD-CUD+ (n=34255) and CUD- (n=34225) cohorts were compared. CUD+ cohort often consisted of males (75.0 vs. 53.8%), blacks (35.9 vs 20.8%) and patients from lowermost income quartile (38.7 vs. 33.5%) (p&lt;0.001). CUD+ cohort had a higher burden of smoking, depression, PVD, and hypertension (p&lt;0.05). Multivariate analysis did not find association between CUD and overall MACCE in CKD patients (aOR 1.05, 95CI 0.93-1.18, p=0.433). Odds of AMI was 1.24 times higher in CUD+ cohort [aOR 1.24, 95CI 1.07-1.43, p=0.005], however, no significant association was found for AIS, cardiac arrest. Inpatient mortality was significantly lower in CUD+ cohort [aOR 0.59, 95CI 0.46-0.75, p&lt;0.001]. Males [aOR 1.20], HTN [aOR=1.31], hyperlipidemia [aOR 1.48], diabetes [aOR=1.01], alcohol abuse [aOR 1.01], PVD [aOR=1.26], cancer [aOR=1.01], South region admissions [aOR=1.31] were significant positive predictors of MACCE in the geriatric-CKD-CUD+ cohort. Smoking (OR=0.79), depression (OR=0.72) and obesity (OR=0.74) demonstrated paradox effect on MACCE with CUD. Conclusions: Recreational cannabis use in the geriatric population with comorbid CKD was not associated with increased composite MACCE, however, increased the risk of AMI.
Abstract 11204: Intraoperative Vital Parameters Improve the Accuracy of Machine Learning Based Prediction Model for Perioperative Stroke in Patients With Non Cardiac Surgery
Authors: Mi-Young Oh, Young Mi Jung, Wonpyo Kim, Hyung-Chul Lee, Jaehyun Lim, Seung Mi Lee
Journal: Circulation (2022)

Introduction: Perioperative stroke is one of the most devastating events after surgery. To prevent perioperative stroke and stratify the patients at risk, several prediction models or scores based on the preoperative factors were suggested. However, there had been never reported a prediction model using intraoperative physiologic parameters. Aim: We aimed to develop a prediction model for perioperative stroke by analyzing pre- and intraoperative factors using machine learning techniques. Methods: This retrospective cohort study included patients who underwent non-cardiac surgery between 2016 and 2019 at Seoul National University Hospital. Perioperative stroke was defined as a newly developed ischemic lesion at diffusion weighted imaging within 30 days after surgery. Preoperative factors were age, risk factors and laboratory data. Intraoperative variables were blood pressure, heart rate, saturation monitoring value, total amount of fluid and urine volume during surgery. We developed a random forest based prediction model composed of pre- and intraoperative factors and compared with a model consisting of only preoperative features. We validated the model in an external cohort of patients at another hospital between 2020 and 2021. Results: A total of 15752 patients were included in the development cohort, and 109 patients had perioperative stroke. In external validation cohorts, stroke occurred in 11 of 449 patients. The area under the receiver operating characteristics curves (AUC) for integrated models using pre- and intraoperative parameters was significantly higher than that of model using only preoperative factors, as shown in figure(0.822, 95% confidence interval, 0.760-0.883, p &lt;0.001). The AUC of integrated model in external validation cohorts showed the trend in line with that of development cohorts. Conclusions: We demonstrated that using both pre- and intraoperative features may improve the accuracy of prediction for perioperative stroke.